<include file="Public:header" />

<style>
.list-group {
	padding: 0;
}
.list-group li {
	border-color:#dff0d8;
}
.list-group li a {
	display: block;
}
.list-group li a .badge {
	float: right;
}
.list-group-item:first-child {
	
}
</style>
<link rel="stylesheet" type="text/css" href="__PUBLIC__/Js/validform/style.css">
<script src="__PUBLIC__/Js/validform/Validform.js"></script>

<div style="padding:5px; padding-bottom:0px;">
  <div class="alert alert-warning" role="alert" style="margin-bottom:5px;"> <strong>温馨提示：</strong>请仔细检查提现账户信息！ </div>
</div>
{$info.res}
<form class="demoform" action="" method="post">
<div class="panel panel-default" style="padding:5px; background:rgba(255,255,255,1.00)">
      <!-- Default panel contents -->
      <div class="panel-heading">请仔细填写信息</div>
      <!-- List group -->
      <ul class="list-group">
        <li class="list-group-item"><input datatype="*" type="text"  class="form-control"  name="depositbank" placeholder="请填写开户行" errormsg="请填写开户行" ></li>
        <li class="list-group-item"><input datatype="*" type="text" class="form-control"  name="accountname" placeholder="请填写账户名" errormsg="请填写账户名" ></li>
        <li class="list-group-item"><input datatype="*"  type="text" class="form-control"  name="account" placeholder="请填写账号" errormsg="请填写账号" ></li>
        <li class="list-group-item"><input datatype="*"  type="text" class="form-control"  name="accountzone" placeholder="请填写开户行地区" errormsg="请填写开户行地区" ></li>
        <li class="list-group-item"><input datatype="*"  type="text" class="form-control"  name="bankname" placeholder="请填写支行名称" errormsg="请填写支行名称" ></li>
        <li class="list-group-item"><input datatype="*"  type="submit" class="form-control" value="确认"></li>
      </ul>
    </div>
 </form>
 <script>
$(".demoform").Validform();
</script>
<include file="Public:footer" />